Rape or coerced sex in girls and women is a frequent and increasing occurrence in the Republic of South Africa. Few studies documenting the short and long term effects have been conducted. It is important to document how different rape treatment services mediate the aftermath of rape. This resubmission in response to PAR-08-223 for innovative collaborations requests three years of funding to follow 154 rural South African women ages 16 and above with recent reports of rape. The sites will be the Thohoyandou Victim Empowerment Programme (TVEP) located in Limpopo Province and the Mafikeng Trauma Clinic located in the North West Province. Women will be interviewed by trained staff within the first 6 months of clinic enrollment and again at 6 and 12 months. Women's psychosocial responses to rape will be assessed and changes related to exposure to different treatment services will be evaluated and compared at the two clinic sites. The Specific Aims are to: (1) Describe the circumstances of rape, and immediate and long-term (6 and 12 months) psychological distress (post- traumatic stress, anxiety, depressive symptoms and somatic complaints) of 154 rural Black South African women at the TVEP in the Limpopo Province and Mafikeng clinic in the North West Province, South Africa;(2) Test moderating variables of psychological distress such as demographics, socio cultural and trauma-related characteristics two treatment sites;(3) Test mediating variables of psychological distress such as social support, coping and treatment related services two time points 6 and 12 months;and (4) Compare and evaluate the influence of treatment related services on psychological distress at two clinic sites, at two time points 6 and 12 months. This proposal seeks to contribute to the gaps in the scientific literature by examining the psychosocial sequelae of rape and treatment-related factors among treatment seeking rural Black South African rape survivors. Also important to this study are possible moderator and mediators in the relationship between psychosocial, cultural beliefs, and treatment factors and psychological distress. PUBLIC HEALTH RELEVANCE: The Fulufhelo Project is a longitudinal study of 154 rural South African females who have been raped in the previous six months at either the Non-governmental supported Thohohoyandou Victim Empowerment Programme, or at the government supported Mafikeng Trauma Clinic in the North West Province. This proposal will increase the understanding of the short and long-term psychosocial sequelae of rape and treatment services to inform tailored treatment services and interventions and increase research capacity within collaborating South African universities.